The World Health Organization clearly states that infertility is diagnosed when a couple of normal childbearing age has not conceived after more than 12 months of regular sexual intercourse without using contraception. Infertility is a special and complex disease that often involves both men and women. In the past, some misconceptions often blamed women for their inability to have children, but as infertility research continues, it has been found that male factors account for about 40% of infertility. The following is a brief introduction to the etiology, diagnosis and treatment of male infertility.
I. Etiology of infertility: can be summarized into five categories.
(1) sexual dysfunction: including impotence, premature ejaculation, seminal emission, ejaculation, etc., ejaculation disorder. It accounts for about 32.4% of the causes of male infertility.
(2) Semen quality abnormalities: including oligospermia, azoospermia, lethal spermia, weak spermia, polyspermia, low semen volume and semen non-liquefaction. It accounts for about 15.4% of the causes of male infertility.
(3) Varicocele: male infertility caused by varicocele accounts for 12%.
(4) Immunological factors: refers to the presence of anti-sperm antibodies in the serum or seminal plasma of men, producing their own anti-sperm immune response, resulting in immune infertility.
(5) reproductive tract infections, congenital anomalies, systemic diseases and unexplained causes of infertility.
Second, the examination of infertility.
(1) Routine semen examination. This is the most basic and important clinical indicator to determine male fertility, the parameters of the semen is the first thing the physician needs to know, the patient should pay attention to: 3-5 days without a room to go to the examination; the best masturbation method to take the specimen; to ensure that all the semen is obtained; 1-2 times in 2 weeks to review.
(2) Microbiological examination related to male infertility. Male urinary and reproductive system infections often lead to male infertility. Pathogenic microorganisms related to male urinary and reproductive system infections include bacteria, viruses, spirochetes, mycoplasma, chlamydia, etc. Commonly, gonococci, papillomavirus, adenoplasma, chlamydia trachomatis, etc.
(3) Seminal plasma biochemical examination. Analysis of the chemical composition of seminal plasma helps to understand the function of the epididymis, prostate and seminal vesicle glands. If the patient has low semen volume, azoospermia, oligospermia, unexplained decrease in sperm motility, congenital defects of the accessory gonads and diseases of the accessory gonads, the seminal plasma biochemical examination can be performed, which commonly includes fructose, carnitine, acid phosphatase, etc.
(4) Endocrine examination related to men. Reproductive endocrine dysfunction affects male sexual and reproductive function and is an important cause of male infertility. Endocrine examination is mainly related to the determination of sex hormones T, FSH, LH, PRL, E2 and various excitation tests, such as HCG stimulation test.
(5) Genetic examination related to infertility. Normal male related chromosomes and genes are the basis for maintaining normal reproductive function, and abnormalities of chromosomes and genes can lead to abnormal sexual differentiation and/or impaired spermatogenesis, thus seriously affecting reproductive function. Therefore, it is of great importance to do chromosome and gene examination for existing sex differentiation abnormalities or other genetic defects in the body, azoospermia and severe oligospermia, family history of genetic diseases, and couples with habitual abortion, such as AZF, etc.
(6) Prostate fluid examination. Prostatitis can lead to male infertility. Prostate fluid examination can provide the basis for the diagnosis of prostatitis.
(7) Testicular biopsy: For patients with azoospermia, testicular biopsy can visually reflect the level of sperm production in the testes and help identify patients with obstructive or non-obstructive causes, so that different treatments can be taken.
Third, treatment of infertility.
Unlike other systemic diseases, male infertility is not a single idiosyncratic disease, but a comprehensive condition caused by multiple etiologies of the male genitalia, including abnormalities at different levels of the internal and external genitalia and gonadal axis, ultimately manifesting as decreased or lost fertility. Because of this, it is impossible to cure male infertility of different causes with one specific drug or method. We use individualized programs for different diseases and treat them according to the evidence.
(1) Segmental obstruction of the vas deferens or varicose veins of spermatozoa
Treatment: surgical treatment.
(2) Low sperm quality
Treatment: Gonadal axis hormone regulation therapy.
(3) Pathogenic infection
Treatment: antibiotic therapy.
(4) Anti-sperm antibody positive person (AsAb +)
Treatment: immunosuppressive therapy.
(5) sexual dysfunction (e.g., ED)
Treatment: psychological counseling or pharmacological treatment.
(6) Male infertility due to chronic prostatitis
Treatment: medication for prostatitis.